We thank FIRST participants, Stupid Cancer!, and Fertile Action for their contributions to this study.
To preserve or not to preserve
How difficult is the decision about fertility preservation?
Article first published online: 26 AUG 2013
Copyright © 2013 American Cancer Society
Volume 119, Issue 22, pages 4044–4050, 15 November 2013
How to Cite
Mersereau, J. E., Goodman, L. R., Deal, A. M., Gorman, J. R., Whitcomb, B. W. and Su, H. I. (2013), To preserve or not to preserve. Cancer, 119: 4044–4050. doi: 10.1002/cncr.28317
- Issue published online: 4 NOV 2013
- Article first published online: 26 AUG 2013
- Manuscript Accepted: 18 JUL 2013
- Manuscript Received: 30 MAY 2013
- fertility preservation;
- decisional conflict;
The decision to pursue fertility preservation (FP) after a cancer diagnosis is complex. We examined the prevalence of high decisional conflict and specific factors that influence this decision using the Decisional Conflict Scale (DCS).
The FIRST project is a web-based survey of female cancer survivors (ages 18-44 years) who have undergone gonadotoxic treatment. We evaluated the association between recalled decisional conflict and referral to FP counseling and demographic, socioeconomic, and cancer variables.
Of 208 participants, 115 subjects (55%) had scores consistent with high decisional conflict (DCS score >37.5 of 100), and 43 (21%) were in the moderate range (25-37.5). In unadjusted analysis, high decisional conflict was associated with lack of referral to FP consultation, not undergoing FP treatment, concerns regarding FP cost, length of survivorship, lower income, education, partner status, and cancer type. In multivariable analysis, significantly higher prevalence of high decisional conflict was observed in participants who were not referred for FP consultation (prevalence ratio [PR], 1.25; 95% confidence interval [CI], 1.06-1.47), as well as in participants who reported cost of FP services to be prohibitive (PR, 1.16 [95% CI, 1.03-1.31]). Prevalence of high DCS was lower for women who underwent FP treatment (PR, 0.67 [95% CI, 0.52-0.86]).
In this study of female young adult cancer survivors, the majority recalled significant decisional conflict about FP at cancer diagnosis. Increasing access to FP via referral for counseling and cost reduction may decrease decisional conflict about FP for young patients struggling with cancer and fertility decisions. Cancer 2013;119:4044–4050. © 2013 American Cancer Society.